Loading...
HomeMy WebLinkAbout13058 (16) �� �� � �` CITY OF DIAMOND BAR k DEPARTMENT OF COMMIJNITY&DEVE OPMENT SERVICES � 21660 E.Copley Drive Suite 190 � (909)86l�3195 Fax(909)861-3117 PRESS �'„�' � BUILDING PERMTT APPLICATION FIRMLY � � JOBSITE C�/��-z �� �j APPLICATION � �'j'`"�ERMI7 � /C � o ADDRESS vC/ /C:77-�i�����-�li� �� DATE _�� � ` TIUMBER�`� � $ ISSUE TYPE OCC APN LOT TRACT DATE CONS7 GROUP � p OWNER �io•,S:Y..����S7�C' � o ADDRESS +�kt� ZONING SETBACKS w CITY�J;xisirut�"J ZIP`� TEL. - �S"� FRONT RW ❑ � APPUCANT TEL. REAR _ ❑_. � SIDEfSIDE STREET RW ❑ - CONTRACTOR �I+T�:.�l�.t:'�.�l.i.c.'6.id�1'_�t'�1� SI�E _ ❑_._—___ � � ..,_ ADDRESS °.��-.3 ::&=&'�:�:�s e41`r � CITY �ef�`'e«gi(:;v:> ZIP ��76'� TEL.��`:�`'iS�-���..�' PROPOSEDUSE ---- w ARCH/ENG! � W DESIGNER NO.DWEL. NO. NO. a ADDRESS UN�TS _ STORIES BEDROOMS___ ` � CITY ZIP TEL. " r�_,n- DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM $ � i HEREBY AFFIRM UNDER PENALTV OF PERIURY TNAT I AM EXEMPT FROM TNE CONTRACTOqS LI� G8f3 E/C8 Oft � W CEN5ELAWFONTHEFOLIOWINOREq50N(SEC.70]1.SBUSINESSANDVNOfES510N5CO�E�ANYCITVOR '(n g � � �J GOUNTYriHICHREOUIHESAPERMtTTOCOPlS7RUC7,pL7[R,IMPROVE.DEMOLISM,DRREPAIRANYSTRUG W P31i0/DBCk �� TURE,PRqR TO iT$19SU/JICE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIQNEO � W STAiEMENT hfAi HE OR SHE IS LICENSED PUR51)AN7 TO THE PROVISIONS OF TXE CANTRACTORS LI- W � CENSE UW�CHAPTEq9(COMMENCING WITH SECTION 70oa)OF OIVISION 30F THE BUSINESS AND PRO� u' Paal/Spa FESSIONS GOOE)OR THAT HE OR SHE IS EXEMPT TMEREFROM ANO 7HE BASIS FOR THE ALLEGEU F.XEMP• � TION.MlYVIOLATIONOFSECTION7031.56YANYMPLICANTFORAPEFMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � A CML PENALT'OF NOT MORE THAN FIVE HUNDRED OOLLARS�S5o0).): Q � ❑I,ASOWNEHOFhIEPROPERN,OPIAVEMPLOYEESWITHWAGE5A5THEIR50LECAMPEN5AT10N, COfI1f11BfClBI ' WILL 00 TME WORK,IWO YHE STRUCi�RE IS NOT INTEN�E�Ofl OFFEflE�FOR SRLE(SEC.�006,0US1• � � NE33 AND PROFESSbHS CODE'.iHE CONTRACTORS LICENSE LAW�OES NOT APPLY TO AN OWNEq OF = ; PflOPERN NhiO BUILDS OR IMPROVES THEflEON,AND WHO DOE&bUCH WORN NIMSELF OR HEFSELF OR � 1HNOVOH HIS OR HEp OWN EMPLOYEES,PROVIDED TNAT SUCH IIAPROVEMENTS AqE NOT INTENDED OR m g W OFFERE�FORSALE.ISNOWEVER7HEBUIL�INGOflIMPPOVEMENT155lN.OWITHINONEVEAROFCOMPLE� ' a � TION,TNE OWNER�BUILDER WILL HAYE THE BURD[N OP PqOVIit6 THAT HE OR SHE DID NOT BUILD OF � = IMPROVEFOfl71iEPlIpPO5E0i5ALE). 4 n4�0�MNEROFTHEPROPER'fV,A/A6XCLUSIVELYCOMR0.CTINGWITHLICENSEUCANTRACTORS - � � TO CONSTftUC�THE PRO.IECT�SEC.�o4a,BUSINESS ANO PROFESSIONS CO[]E:TNE CONTHACTOFlS LI� V81U8fI0h ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNF.ROFAPROPERTYWHOBIlILD50RIMPROVESTHERF.ON,PN� ��� -' � ZWrfOCpNTMCTSFORSUCHPRQIECTBWITHAC07JTRACTOR�S)LIC'cNSEDPURSUANTTUh1EWNTRA0. Q�JqNTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM E%EMPT UNDER SEC. _ _.__B.&P�C.FOR7h115 REASON J _, � U � � DATE _OWNEA '_'_ ...-_.. V � � UCENSED CONTRACTORS DECLARATION W � � 1 NEREBV AFFIRM UNOEfl PENALTYOF PERJURY THAT I AM UGENSED UN�EP PROVISIONS OF CHAPTER � � � �S�.,�,.�/�� e � � 9(COMMENCIN(i WIM SECTqN 7000)OF DIVISION 3 OP THE BUSINESSAND PROi ESSIONS COD[,AND Z !'� n�L�r�.�,s. � MY LICENSE IS IN FULL FORCE AND EFFECT. "''�'� � � � ���ENSE�LA55 �':�•'�' ���.N�._f�" ��- j � ��`�^1� �� .. � 9 V DATE,_._���_��t�.�_CONTRACTO _ f�.. �, _ d W � � WORKERS'COMPENSATIUN UECLAHATION � y U - � N 1 HEREBYAFFIRM UNDER PENRLTY OF PEP.IURV ONE OF THE FOLLOWING DECLA(1ATIONS: 7 'r� Q � � �I HAYE AND WILLMAINTAIN A CERTIFICATE OF CANSENT TO&ELF-INSURE FOR VlORKEP.S' _ • � COMPENSA7KKJ,ASPROVI�EDBVSECTIIXV77600FTHFlABORCA�E,FORi'HEPERFORMANCf. �U [ OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED. � $ d � W __I HAVE M1D WILL.MAINTAIN WORKERS'CAMPENSA710Y IN8lJRANCE,AS R[aIlIFEO BY SECTION Q 37000FTMELABORCWE,FOFTHEPEfiFORMANCEOFTHEWORKWRWHICHTHISPERMITIS � � ISSUED.MY WOPKER5'CIX.IPEN5RTION INSUfiANCF GARFIER ANO VUUGY NUMBEFARE: CONSTRUCTION __,__, �' � -,�.�7,v7� . .._ i CARRIER. "-��LL`ry .. .� . �C'_la,.�i�. T.__ PLANREVIEW __...__..,... -....._...--- --'-' - � � ;:� . . e =�-.-A.._ .,� �--._._ .._-.._ '-- ;. Z POI,ICVNUM9ER_ + '��` � m - �LECTRIC Y � .3�=S—"-_'- Q ..__..__ ..'—_. ._'__..._ . ^ * .,... 0 (fHA4SEl.'lIONNE�NOTHECONIPLETEDOFTW-PEliWTISFORohCMA+i]REDUCLl1J>S�Stuc)ORLESS). �MLING ..__'. .`_'_", "_.__.�' '_k — f. W +Y�i G..is.� � Z ICFATIFYTHATINTHEPEFFORMANCEOFTH[WORICFORWHICHTHISPERAIiTI51S5UED,1 CHANICAL � -_ ..'_" "'__'' __"-_' (�} SHALLNOTEMPLOYANYPERSONINAN7MnNN[RSOASTOBECAMESUBJECTT07HE INSPECTIONFEE F � WORKEftS'COMPENSA710N LAWS OF CAIIFORNIA,ANUAGREE THAi IF I SHOULD BECOMF' ..._.._._.__ ' ""___'_"'_ _'-" - - SU&IECT TO THE WORKERS'COMPENSATION PFOVISIONS UF SECTIO�S7a09F TH[LABpp � � � CODE.ISHALI.FORTHW�THCOM�THO5E'PF0415ADN5. ISSUANCE .,,,___ .._ , ___'- o ...,- - � —� ��-r"r-� _ -y �^ .. � �.� APPLICA.'r. �----- -J-'-•:'`e,•.�_yy SMIP � ' � p DATE�. G�--! .. . _...-......p _...._-..._ �...._— ___ �yy r� py W ��- ENERGYP/C ''t'�`��+..sF" !{ i �e. -�_-q 1. i� �.._.._� � . .LY.�# . WARNINO:FAILURfTOSECUREWORKERS'COMPENSATIONCOVERAGEISUNIAWfUL,ANDSH�LLBE r-'--"-" "' -- SU[iIECTANEMPIOYERTOCHIMINALi'ENPLTIESAN�CIVILFINESUP700NEHUNDREDTHOU9AND ��J�,��T�T�r '" "�" LL DO�LARS(5100.oa0),INADDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPHOVIUEUFORW ENERGYPERM _ �-�� � � � � j� -...._ ':_..._._._ ....'_'-'' ,�", -"'_...__ � SECTIDN37080FTHELABOHWD[,INTERESLANDATTORNEV'SFEES RETENTIONFEE: ._,._.. "-_.._. ....._'_... _-'._ �p O CONSTRUCTION LENDING AGENCV PRE-ALT FEE: �' -�-- -----. __..---.... .--- �a � IHEREBVAFFIRMUNDERPENALNOFP[NJURYTVIATTHEREISACON5TftI1CTIONLEN�INGAGENCY �.0 FOR7HE PERFORMANGE DF THE WORK FOR WlIIGH THIS PEflM1T IS ISSUED�SEC.9097,CIV.C.). -""- ---- �•-�- �--�-� .__.._. {5 _'— Z `% w _- "-'.. .__._ ...-' '"_. .,_'--' [. � LENDEF1'SNAME_'._"�-' ""___ __'_ -. .._ � " "'-""' '"__'... '"_....-.--_'-- M F_ LENDEH'SADDRESS___ . ..._.._ .-_... 'E � ICEHTIFYTHATINAVEREq�iHISAPPLICATIDNANDSTATETNATTHEABOVEINFORMATIONISCORRECT. IUTALFEEJ / � � /� A !/! Q I AOREE TO COMPLY WITH ALl CIIY AND COUNTV OFlOINANCESANU STATE LAWS RELAiING TO BUIL�ING � V � CANSTRUCTION,AND HEREBY AUTHORIZE AEPflESENTPTNF.S OFTHIS COUNIY TO ENTER UPON THE ABOVE•MENTIONEO PHOPERTY FOR INSPECTION PURP0.5E5. !� Z COMMENTS___. � y -- -- - ------- -' `_�,__ �i?r,�.c..o�r.%_'�S.f.� — � -- -- — _.. ---- --� ----- m PEFiMITT NAME(PRINT) ^ —' "_ "__" '-_ _- - � �� �-��` �), � S I ����.� ---f,. 1-_.�.��_ � ( � UJ SIGNA7UREOFPENMITTEE ^""-^ DATE � � - ���" � = R[CPt NO.., __�PAID 8Y VALIDATION�_:._., ~ WHITE--0epertmant Copy,YELLOW-Finance Copy,PINK-Assessor COpy�GOLDENROD-File Copy,GREEN-ApplicanYs Copy .. _.., ..... . . .4F . i ' [""' _ � _ _ .- .�� .. _. � 1 % : , .; � � _ � � � I � 1 LL1Y - • t . l f � I � ' : ' . . F . , , . . . i '�... I i � 1 I b � � � . i i , � - . • ' : . � � ; ' ,, ' � 7 . . ' I � I f .. � i I I ' I . 1 1 _ . .. . � � ,.� . . �'. � I "�' � _ . ,, 1 : . ' ,. ., ', i I . � ,,, � . ,. , ! ' . . ' . .. . . i' I . � I �, . I I' . . � I ',, ' � ��. i � - . . ,, . , I . � � ��. _ �.'. '._. � i � � . . ` ' � _ . . . '... , � i . � 4 ! . � � . I . � � , { , � �, � � , I i i... � i r r �, �i , i,, . . .i . , ; '- ...._... . i t '. ' .._ i ;...._ � '.._ i ;. ; j.. k ' ' �. . , � i !; , ) � � I I � . . , , � ' . � , . , �� I , , ' { � ; R n. � I � � � � ; ; , , , ! � � � ; i � � � 3 ' ' � I � .. �3 " � ;.` ' . . , .. � .' : - ,� I I � � 4 �� � i , � i � . , I - ,.. � ..' � . 1 ' . . i _ ��� � t.�. �{ . . � � w �� r ' _ . � � ' I i .. �� t y. � . . , _ i-_4 � ' - � '� �' , � ' ' j = t 1 P � t I � : , 1 � . , � , • 1 1 • . k � r ; � , : _ -, , , : . t s . : E ' I ` j � � i I , ��' ' I � � I ' � . � � � . .. � , . , , i � . . � .. � � .,. '. .. � . � i ,. � i � ' i �' , � � 8� _ � � • ' ': , ' . ��,' � � I, , ' I � I { � 4 i �: 1 � ', . �� ' . ........ ... . � � i , . ; ' . . � ,�, � � � ' , , . � � � . : � � .. I � _ . ' ,, � , i , � . � , i . � �. . . . � . . . , . ' . � , I . ,. . ,, . � , i ' ,. i _ �.� , `. . ,, . . , , : �� � �,a I , ' , '! ,, . . , , , ! � , i � , ' _-�_ i ; ' i r , � , � � � � � i � i-.. . _._.. .�_ . _ ; . � � . � , . :_. • ,, :, ' � I : , ', � , � I i � I i � .% ; . i . , � _ i , ; _ ;i - � ' . .. E . i _ t� � - r ` - . ' � , i , � ; - ' � � ] , = � ° - - ; .. �...., . � ` . . . u , , � . :: ��, ., .. � ,.. . _... . . f �.: . - . . � � - .. . . � , _ . . �-. . � � - . . . ...:. . _ ,_ . � � ' . . , - -. .�... ... ..... . ' .• - . •,s